Neurophysiological Studies of Abnormal Night Sleep and the Pickwickian Syndrome

The Pickwickian syndrome of periodic somnolence with obesity and hypoventilation is reported in detail with studies of respiration and electroencephalogram (EEG) during nocturnal sleep.

Abstract

This chapter discusses abnormal sleep syndromes investigated with continuous recordings during nocturnal sleep. The Pickwickian syndrome of periodic somnolence with obesity and hypoventilation is reported in detail with studies of respiration and electroencephalogram (EEG)during nocturnal sleep. The short diurnal periods of light sleep (10–12 seconds duration) in Pickwickian patients are characterized by apnea, increased cyanosis and muscular relaxation, simultaneous with sudden flattening of the EEG and slowing of the α-rhythm. The night sleep of Pickwickian patients is interrupted by long apneic periods of 20–40 seconds duration, terminated by 1–3 deep irregular snoring breaths. During the apnea, EEG rhythms are usually slowed and the amplitude increased. The δ-waves and sharp waves appear associated with spindles. At this time, there is bradycardia and deep cyanosis. With the return of respiration α-waves appear and the heart rate increases. Pickwickian patients rarely attain the deep sleep stages D and E, and long periods of rapid eye movements are lacking. When such paradoxical REM stages occurred in two patients, the respiration became more shallow and regular. In stage C sleep, which is the predominant sleep stage in these patients, the apneic periods were most pronounced.